‫المملكة المغربية‬

‫وزارة الداخلية‬
‫عمالة المحمدية‬
‫الصورةبني يخلف‬
‫باشوية‬
‫المحلقة األولى‬
‫رقم ‪........... :‬‬

‫شهادة السكن‬

‫نشهد نحن عون السلطة ان المسمى (ة) ‪:‬‬

‫االس‪%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%‬م‬
‫الشخصي ‪.................................................................................................:‬‬
‫االس‪%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%‬م‬
‫العائلي ‪....................................................................................................:‬‬
‫رقم بطاق‪%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%‬ة التعري‪%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%‬ف‬
‫الوطنية ‪....................................................................................:‬‬
‫ت‪%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%‬اريخ و مك‪%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%‬ان‬
‫االزدياد ‪..........................................................................................:‬‬
‫اسم االب ‪........................................................................................................:‬‬
‫اسم االم ‪.........................................................................................................:‬‬
‫الحالة العائلية ‪..................................................................................................:‬‬
‫متزوج (ة) بالسيد (ة) ‪.........................................................................................:‬‬
‫المهنة ‪...........................................................................................................:‬‬
‫العنوان ‪..................................................................................:‬بني يخلف المحمدية‬
‫قاطن (ة) بهذا العنوان ‪.........................................................................................:‬‬

‫بني يخلف في ‪.................................:‬‬

‫امضاء المقدم‬
‫امضاء الشيخ‬